Finally, we know that cultural variation in pain expression is widespread. The accepted display behaviours associated with pain are dictated by social, not biological rules. And if differences occur between cultures, then they must also occur within cultures. Men are expected to tolerate pain more than women. This raises interesting questions. For example, does someone who complains more loudly and emotionally actual experience more pain as a result? Do men and women experience different levels of pain (women report more pain than do men) or just complain differently? Because of these different rules for pain expression are women ‘s pain complaints treated as more “trivial” by staff, receiving less attention than men’s complaints? (Women, it seems are no less likely to receive analgesia than men, but nurses under estimate both men and women’s pain levels), (Fielding, 1994). These and other features are powerful arguments for considering pain to be as much an emergent property of (social) perception than simply a feature of neuronal activity.

However, perhaps the most convincing argument for considering pain as a perceptual phenomenon is the concept of desynchrony. This refers to circumstances when the four components of the pain experience (sensation, emotion/motivational/behavioural/social) are not synchronized. This may be seen when a medical condition stabilizes or improves , yet patients continue to report increasing pain, or when serious injury occurs, but little pain is experienced (as Beecher reported in his wartime patients). Physiological models implicate descending cortical neuronal inhibitory or excitatory influences on the spino-thalamic tract (the so-called “Gate theory of pain”). But all this tells us is that sensation input is modulated, hardly surprising given that most other sensory inputs to the CNS are also under some form of higher control.